what is immune system damage?

Question

Right or wrong, it has been my goal to delay treatment as long as possible. 10 years since infection and I'm still med free with good labs. However, I have seen the phrase "damage to the immune system" in reference to not starting meds and in reference to other issues. My docs speak strictly in terms of CD4 & VL counts when describing immune system health. Could you explain what "damage to the immune system" is? I have always read the phrase in the context that such damage is permanent. Your clarification is appreciated.

Answer

Thank you for your post.

The phrase you refer to is frequently used in very loose terms. The reason for this is that it really is not very specific or well defined. I suspect most use it to describe immunologic deficits that occur in people that can not be measured by blood CD4 cell count. While there certainly is data that this occurs, even within the first weeks of infection, and some of this damage may be irreversible, in the clinic the major focus remains on CD4 cells counts that we can measure.

From my perspective it is vital that immunologists continue to research the importance of "damage to the immune system" that can not be measured in the clinic. Nevertheless, from a patients view there is no data demonstrating that this is more important than what we can measure with CD4 counts. For now I would encourage you and others to focus on the routine markers since they appear to be very useful in guiding the current management of HIV disease. Only time will tell whether these other issues will prove to be relevant in clinical practice.

Best, Eric